Eliminate All Variables

What role does patient education play in moving more complex procedures to an ASC setting?
It’s one of the key factors in a successful surgery. You want to give people the most information possible so there are no surprises. When I started performing outpatient surgery in 2008, same-day wasn’t the norm. It was pretty much unheard of. We had to drive home why we were doing the procedure the way we were and say, “We’re not going to perform your procedure in an inpatient setting — we’re going to perform it outpatient. These are the reasons why.”

Can you describe the education model you created?
The idea behind it is straightforward: When patients are properly educated about what their surgery is going to involve, anything is possible. When patients see me in clinic, I say, “This is the problem you have, these are your treatment options and this is the surgery I recommend.” At the same time, I’m telling them we’ll be doing the procedure in the outpatient setting. From the moment I have this conversation on, everything is geared toward helping patients understand every step of their care process so that by the time I see them again on the day of surgery, they don’t have questions because everything has been covered by our staff. We try to eliminate any variable so that when a patient comes in for surgery, all they’re worried about is their transportation home.

Why is there such a buzz about outpatient spine surgery?
There are three factors that make it desirable for health systems. First, cost savings. There’s no study in which outpatient is more expensive than inpatient surgery. Second, you can control the entire surgical experience, from beginning to end, because you create an environment where every aspect of care is handled by a group of experts who know exactly how to do the most safe, efficient and reproducible procedure possible. Finally, there’s a financial benefit. Whether it’s that the procedure is more efficient or you can do more in less time or the surgeons have a financial stake in the surgery center, there is an incentive to move more procedures to ambulatory ORs.

What will outpatient spine surgery look like five or 10 years from now?
I think it will become the norm for most procedures. Inpatient stays will be reserved for patients who have multiple medical problems — or for operations that are quite intensive in terms of duration, potential for blood loss or the need for rehabilitation. Also, more complex procedures that generally require additional resources, like deformity operations, will likely stay in the hospital setting. Finally, surgeries that are very expensive — involving implants that cost $50,000, $60,000, even $100,000 — are likely to stay inpatient because the financial constraints make it so facilities aren’t contracted to perform the procedures outpatient. But overall, we’re going to see the bulk of spine cases migrating to the outpatient setting in the very near future. OSM